Identifying patients at risk: multi‐centre comparison of HeartMate 3 and HeartWare left ventricular assist devices

Abstract

Abstract Aims Since the withdrawal of HeartWare (HVAD) from the global market, there is an ongoing discussion if and which patients require prophylactically exchange for a HeartMate 3 (HM3). Therefore, it is important to study outcome differences between HVAD and HM3 patients. Because centres differ in patient selection and standard of care, we performed a propensity score (PS)‐based study including centres that implanted both devices and aimed to identify which HVAD patients are at highest risk. Methods and results We performed an international multi‐centre study (n = 1021) including centres that implanted HVAD and HM3. PS‐matching was performed using clinical variables and the implanting centre. Survival and complications were compared. As a sensitivity analysis, PS‐adjusted Cox regression was performed. Landmark analysis with conditional survival >2 years was conducted to evaluate long‐term survival differences. To identify which HVAD patients may benefit from a HM3 upgrade, Cox regression using pre‐operative variables and their interaction with device type was performed. Survival was significantly better for HM3 patients (P 2 years after implantation (P = 0.03). None of the pre‐operative variable interactions in the Cox regression were significant. Conclusions HM3 patients have a significantly better survival and a lower incidence of ischaemic strokes and pump thrombosis than HVAD patients. This survival difference persisted after 2 years of implantation. Additional research using post‐operative variables is warranted to identify which HVAD patients need an upgrade to HM3 or expedited transplantation.

Keywords

• Left ventricular assist device
• LVAD
• End‐stage heart failure
• Mechanical circulatory support
• Centrifugal continuous flow pump